• 4.1 million People

Maori 14%

Population

Maori 14%

Pacific People 6%

Asian 6%

• 39.9 million sheep

• The New Zealand Health System

• New Zealand Health Information

Paul Cressey

• New Zealand Health Information

• eMedicine NZ Context

• Safe Medication Management Programme

NZ Health

• 21% Govt Budget

• $12 billion• $12 billion

• 9.45% GDP

• Government Funded 80%

• Primary Care 40%

• Secondary Care 60%

National Health Strategies

• NZ Public Health and Disability Act 2000Act 2000

• NZ Health Strategy 2000

• Primary Care Strategy 2001

• Health Information Strategy for NZ 2005

• Accident Compensation Commission

Counties Manukau District Health Board

• Population 410,000

• Budget $1 billion• Budget $1 billion

• Hospitals and Primary Care

•Primary Options Acute Care

•Chronic Care Management

•Lets Beat Diabetes

Health Information Strategy Action Committee

• Ministerial Committee

• Governance, Oversight, Leadership• Governance, Oversight, Leadership

• Sector Leaders

• Infrastructure Subcommittee

• Health Information Standards Organisation

• National Collections Subcommittee

Health Information Strategy for NZ

• National Networking

• Anchoring Framework

• National Health Index

• Health Provider Index • Anchoring Framework

• Primary Care Information

• Chronic Care Management

• Outpatient Information

• National System Access

• Health Provider Index

• e Laboratory

• e Pharmacy

• e Discharges

• e Referrals

EMRs in New Zealand

9298100

100

Percent 7 (14) functionsPercent uptake EMR

9289

79

42

2823

98

0

25

50

75

100

NET NZ UK AUS GER US CAN

8783

72

59

32

19

8

0

25

50

75

100

NZ UK AUS NET GER US CAN

Referrals and Discharges in NZ

New Zealand RSD Messages

Jan 05 - Nov 07

235000

95000

115000

135000

155000

175000

195000

215000

235000

January

05

Febru

ary

05

Marc

h 0

5A

pri

l 05

May 0

5June 0

5July

05

Aug

ust

05

Sep

tem

ber

05

Oct

obe

r 05

Novem

ber

05

Decem

ber

05

January

06

Febru

ary

06

Marc

h 0

6A

pri

l 06

May 0

6June 0

6

July

06

Aug

ust

06

Sep

tem

ber

06

Oct

obe

r 06

Novem

ber

06

Decem

ber

06

January

07

Febru

ary

07

Marc

h 0

7A

pri

l 07

May 0

7June 0

7July

07

Aug

ust

07

Sep

tem

ber

07

Oct

obe

r 07

Novem

ber

07

Month

No o

f M

essag

es

7582

68

76

75

100

Referrals

Receive Information Back from referral (80% or more)

37

6168

62

0

25

50

75

AUSAUSAUSAUS CANCANCANCAN GERGERGERGER NETHNETHNETHNETH NZNZNZNZ UKUKUKUK USUSUSUS

Hospital Discharges

10015 days or more to receive a report

28

5853

48

17

52

23

0

25

50

75

AUS CAN GER NETH NZ UK US

New Zealand Approach

Lab

GP (EMR) Radiology

Drug

LabGP

Patient Point of

Care

GP (EMR) Radiology

Pharmacy

Hospital Specialist

EHR

Specialist

Lab

RadiologyHospitals

GP

Centralised (push

and pull)Point-to-point

(push)

NationalViews

District / RegionalViews

Appropriate views / subsets of the information below.

Relevant views of information above.

Information Flows

Individual

Local Views

Capture, use, and share

information locally at the point of care.

Standards

Indicators

Health Outcomes

Shared Health Event Summary “Patient Vitals”

eMedicine NZ ContexteMedicine NZ ContexteMedicine NZ ContexteMedicine NZ Context

• Only 27% GP Referral letters had accurate medicines

• Only 52% of Surgical wards medication wards medication histories accurate

• 25% inaccuracies in discharge prescriptions

HISAC Health Information Strategy ActionCommittee

ePharmacyAction

Plan

ePharmacySector Leaders

Forum

Universal “list of medicines”

GP to Rx Pilot

eMedicine NZ ContexteMedicine NZ ContexteMedicine NZ ContexteMedicine NZ Context

HISO Medicine Term Messaging Stds

Expert Advisory Groups

Universal

eRx Message

Medicine Terminology

QICQuality Improvement Committee

DHB Safe Medication

Management Project

Standardised Medication Chart

Bedside Verification

Hospital Medication

Pilots

Sector Plan

Secondary

Primary

General PracticeCommunity Pharmacy

Rest Home / Private Hospital

Medication

Prescription

DischargeReferral

Report

Claim

eMedicine NZ ContexteMedicine NZ ContexteMedicine NZ ContexteMedicine NZ Context

Hospital Ward

Prescription Repository

CCM Programme

Hospital Clinician

HPaC Payments

Hospital Pharmacy

Prescription

Local NationalRegionalReferral

Prescription

Prescription

Medication

Universal Medicine Message

Prescribing MIMS

BNF PHARMAC schedule IPA & PHO CME Guides Hospital Lists

New Zealand Australia UK

NHS Dictionary of Medicines & Devices (dm+d)

(Snowmed CT)

Australian Medicine Terminology (AMT)

(Snomed CT)

eMedicine NZ ContexteMedicine NZ ContexteMedicine NZ ContexteMedicine NZ Context

Distribution

Australian Catalogue of Medicines (ACOM)

(GS1 Net)

Hospital Lists

Supply Chain Pharmaceutical Products

(GS1)

DispensingGuild Catalogue

Pharmac Schedule

(Pharmacodes)

Current Lists and Codes

Decision

Support

Medicines

Terminology

Snomed / Australian Medicine Terminology

eMedicine NZ ContexteMedicine NZ ContexteMedicine NZ ContexteMedicine NZ Context

Medicines

Encyclopaedia

BNFNZ

MIMS

Medicines

Catalogue

Guild

GS1

Terminology

National Medicines Reference System

Australian Medicines Catalogue

Amoxycillin

Australian Medicines

Amoxycillin 250mg

Amoxil 250mg

Amoxil

Pharmac Schedule

MedsafeSchedule

eMedicine NZ ContexteMedicine NZ ContexteMedicine NZ ContexteMedicine NZ Context

Medicines Catalogue

250mg capsule

Amoxycillin 250mg

capsule 20

Amoxil 250mg

capsule 20

250mg capsule

GS1 Catalogue

Amoxil 250mg

Capsule 20 Blister Pack

Guild Catalogue

NZ Medicine TerminologyNZ Medicine Catalogue

Universal Medicines List

Safe Medication Management Safe Medication Management Safe Medication Management Safe Medication Management

• 5,000 Patient Medication Errors a year

• 3,500 Patients Temporaily Disabled

Challenge

• 3,500 Patients Temporaily Disabled

• 400 Patients Permanently Disabled

• 150 Patients Die

Safe Medication Management Safe Medication Management Safe Medication Management Safe Medication Management

• GS1 NZ

• Ministry of Health Official

History

• Ministry of Health Official

• Minister of Health

•“Barcoding Project”

• Quality Improvement Committee

• Lead District Health Board

Safe Medication Management Safe Medication Management Safe Medication Management Safe Medication Management

• Optimising Patients Journey

• Management Healthcare Incidents

Quality Improvement Committee Projects

• Management Healthcare Incidents

• Infection Prevention and Control

• National Mortality Review Systems

• Safe Medication Management

• Improving Customer Participation

• Education and Training in Quality Improvement

Safe Medication Management Safe Medication Management Safe Medication Management Safe Medication Management

• Reduce the number of medication errors in NZ

Objectives

errors in NZ

• Reduce the number of patients who are permanently disabled or die as a result of medication errors

• Reduce the costs associated with remedial treatment

Safe Medication Management Safe Medication Management Safe Medication Management Safe Medication Management

• Standardised Medication Chart

• Medicine Reconciliation

Eight Hospital Projects

• Standardised Hospital Medicine Systems

• eMedication Record, ePrescribing

• Link Medicine Management Systems

• Unit Dose Packaging

• Introduction Bedside Verification

• Training

Safe Medication Management Safe Medication Management Safe Medication Management Safe Medication Management

• Universal eMedicines List

• Universal eMedicine Messaging

Four Sector Projects

• Universal eMedicine Messaging

• ePrescribing GP to Rx

• Sector Collaboration

Paul Cressey